Schwartz EJ et al. (2005) Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 16: 2412–2420

The epidemic of HIV-associated end-stage renal disease (HIV + ESRD) is projected to worsen over the next 15 years despite the use of highly active antiretroviral therapy (HAART), according to a retrospective analysis of epidemiologic data from the US. Previous claims that the problem is under control might be dangerously misleading.

As most sufferers of HIV-associated nephropathy are black, a predictive model was developed using data from black AIDS and ESRD populations. Inclusion of data from 4 years before to 7 years after the introduction of HAART, together with infection rate, permitted assessment of the effect of HAART on the prevalence of HIV + ESRD to date. The validated model was then used to estimate prevalence through to 2020.

HAART was seen to have had a positive impact on AIDS growth rate since its introduction in 1995. It has also slowed progression to ESRD by at least 38% and reduced ESRD-associated mortality by 67%. Unfortunately, the model predicts that current linear rates of HIV infection will negate these positive effects, causing the HIV + ESRD population to grow steadily over the next 15 years. This increase will manifest even if the efficacy of HAART in blocking progression to ESRD reaches 95% or ESRD-associated mortality decreases to 10%.

The authors conclude that the HIV + ESRD epidemic is far from reaching a plateau. They recommend more widespread implementation of HAART and an emphasis on preventing new infections.